People  with  a  CD4  cell  count  over  200  cells/μL  usually respond  to  a single total body application of  topical  permethrin  (5%)  left on for 8 to 14 hours, and repeated after  1 week. If permethrin is not available, benzyl benzoate 25% emulsion applied for 24-36 hours may be used. The lotion is usually applied once daily at night on 2 or 3 consecutive days. Sulphur 5-10% in cream or paraffin for 3 consecutive days and repeated in 1 week, may be another alternative option, particularly for neonates. (101) Treatment also involves hot water washing and drying of clothing and linen harbouring the mite, and prophylactic treatment for all household members and sexual contacts.  

Often, topical treatment does not penetrate the lesions of crusted scabies sufficiently for eradication. Therefore, keratolytic treatment with topical salicylic acid 5-10% or urea 40% can be given concomitantly. (102) In adults, systemic therapy of oral ivermectin 200 μg/kg in two doses two weeks apart can be given, and is recommended for immunocompromised patients including those with advanced HIV infection and CD4+ cell count below 200  cells/μL. However, topical permethrin has a faster onset of action in terms of itch control and reducing lesions count. (103)